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Hervé RC, Bryant C, Sutton L, Cox C, Gião MS, Keevil CW, Wilks SA. Impact of different hand-drying methods on surrounding environment: aerosolization of virus and bacteria, and transfer to surfaces. J Hosp Infect 2024; 147:197-205. [PMID: 38521417 DOI: 10.1016/j.jhin.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In recent years, hand drying has been highlighted as a key step in appropriate hand hygiene, as moisture on hands can increase the transfer of micro-organisms from hands to surfaces and vice versa. AIM To understand bacterial and viral aerosolization following hand drying, and study the transfer of micro-organisms from hands to surfaces after drying using different methods. METHODS Groups of five volunteers had their hands pre-washed with soap, rinsed and dried, then inoculated with a concentrated mixture of Pseudomonas fluorescens and MS2 bacteriophage. Volunteers entered an empty washroom, one at a time, and rinsed their hands with water or washed their hands with soap prior to drying with a jet dryer or paper towels. Each volunteer applied one hand successively to various surfaces, while their other hand was sampled using the glove juice method. Both residual bacteria and viruses were quantified from the washroom air, surface swabs and hand samples. FINDINGS P. fluorescens and MS2 bacteriophages were rarely aerosolized while drying hands for any of the drying methods studied. Results also showed limited, and similar, transfer of both micro-organisms studied on to surfaces for all drying methods. CONCLUSION The use of jet dryers or paper towels produces low levels of aerosolization when drying hands in a washroom. Similarly, all drying methods result in low transfer to surfaces. While the coronavirus disease 2019 pandemic raised concerns regarding public washrooms, this study shows that all methods tested are hygienic solutions for dry washed hands.
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Affiliation(s)
- R C Hervé
- School of Biological Sciences, University of Southampton, Southampton, UK.
| | - C Bryant
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - L Sutton
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - C Cox
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - M S Gião
- Dyson Technology Ltd, Malmesbury, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - S A Wilks
- School of Biological Sciences, University of Southampton, Southampton, UK
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Effect of Optimal Alcohol-Based Hand Rub among Nurse Students Compared with Everyday Practice among Random Adults; Can Water-Based Hand Rub Combined with a Hand Dryer Machine Be an Alternative to Remove E. coli Contamination from Hands? Microorganisms 2023; 11:microorganisms11020325. [PMID: 36838290 PMCID: PMC9963388 DOI: 10.3390/microorganisms11020325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Efficient hand hygiene is essential for preventing the transmission of microorganisms. Alcohol-based hand rub (ABHR) is a recommended method. We compared health personnel (skilled nurse students) with random adults to study the effect of an ABHR procedure. A water-based hand rub (WBHR) procedure, using running tap water and a hand-drying machine, was also investigated. The study included 27 nurse students and 26 random adults. Hands were contaminated with Escherichia coli, and concentrations of colony forming units (CFU/mL) were determined before and after ABHR or WBHR. Concentrations after ABHR were 1537 CFU/mL (nurse students) and 13,508 CFU/mL (random adults) (p < 0.001). One-third of participants reported skin irritation from daily ABHR. Concentrations after WBHR were 41 CFU/mL (nurse students) and 115 CFU/mL (random adults) (p < 0.011). The majority of participants (88.5%) preferred the WBHR method. Results from 50 air samples from filtered air from the hand dryer outlet showed no CFU in 47 samples. A significant difference between the two groups was shown for the ABHR method, indicating that training skills are important for efficient hand hygiene. Surprisingly, the WBHR method seemed to have a significant effect in largely removing transient bacteria from hands.
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Rahman Zuthi MF, Hossen MA, Pal SK, Mazumder MH, Hasan SMF, Hoque MM. Evaluating knowledge, awareness and associated water usage towards hand hygiene practices influenced by the current COVID-19 pandemic in Bangladesh. GROUNDWATER FOR SUSTAINABLE DEVELOPMENT 2022; 19:100848. [PMID: 36164324 PMCID: PMC9493147 DOI: 10.1016/j.gsd.2022.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Hand hygiene is considered as one of the most effective ways for preventing transmissible diseases, especially for preventing virus-borne diseases. The study has been conducted to evaluate changes in knowledge, awareness and practices of hand hygiene due to the outbreak of the coronavirus disease (COVID-19) in Bangladesh. The potential factors influencing human behaviours for maintaining hand hygiene have also been explored. Moreover, a probable increase in daily water demand associated with the changed situation has been assessed. An online survey was performed among a total of 367 Bangladeshi residents about their practices of hand hygiene during pre-corona, corona, and of their perceived future practices at post-corona period. It has been observed that a significant percentage (62.1%) of the respondents have received basic hygiene education at any level of their academic education. Nevertheless, their hygiene practices were very poor before the COVID-19 pandemic. The outbreak of the COVID-19 has reinforced their previous knowledge and greatly influenced their behavioural changes towards practicing hand hygiene as per World Health Organization guidelines for preventing the virus outbreak. The changes, however, have created increased water demand. The estimated water usage is found to be 2.68 times (9.15 L/c/d) and 2.52 times (8.59 L/c/d) higher in the corona and post-corona period respectively than that of the pre-corona situation (3.41 L/c/d). The principal component analysis (PCA) elucidated that an individual's practice of hand hygiene was associated with income, level of academic and hygiene education, and the COVID-19 outbreak itself. Moreover, the influence of hygiene education and COVID-19 outbreak affecting the duration of handwashing are found highly significant (p-value < 0.001) from the regression analysis. Raising awareness towards behavioural change of an individual about water usage, improvement of academic curriculum regarding hand hygiene and provision of water pricing are recommended to attain sustainable development goals of the country.
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Affiliation(s)
- Mst Farzana Rahman Zuthi
- Center for Environmental Science & Engineering Research (CESER), Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Md Arif Hossen
- Center for Environmental Science & Engineering Research (CESER), Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Sudip Kumar Pal
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Maruful Hasan Mazumder
- Department of Disaster Engineering and Management, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - S M Farzin Hasan
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Md Muzamamel Hoque
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
- Southern University Bangladesh, Chattogram, 4000, Bangladesh
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5
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Moura IB, Bentley K, Wilcox MH. Assessment of potential for viral contamination of user and environment via aerosols generated during hand drying: A pilot study. Front Public Health 2022; 10:1010802. [PMID: 36388368 PMCID: PMC9641239 DOI: 10.3389/fpubh.2022.1010802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023] Open
Abstract
Background Hand drying is an essential step of hand hygiene, helping remove microbes remaining on hands following handwashing. However, it is unclear whether particles dispersed or aerosolized during hand drying can also have an impact on microbe dissemination and so pose an infection risk. Methods We used a PR772 bacteriophage to investigate whether microorganisms remaining on hands can disperse in the washroom environment and contaminate facemasks of others sharing the same space, as a surrogate for virus inhalation risk. Hand drying using either a jet air dryer or paper towels were performed, and mask contamination by splattering and droplet deposition was investigated, up to 15 min following each procedure. Results Facemask contamination by splattering was 10-fold higher when a jet air dryer was used, compared with hand drying by paper towels, for both the person performing the hand drying and for standby users stationed at 1 and 2 m distance. Facemask contamination by droplet/aerosols deposition was higher in the first 5 min following hand drying, for both methods; however, virus load was significantly higher when a jet air dryer was used. In the jet air dryer assays, facemask contamination increased at 15 min post-hand drying, suggesting aerosolization of small particles that remain airborne for longer. Conclusion When using a jet air dryer, virus contamination dispersed further and for a longer period of time (up to 15 min post hand-drying). The method chosen for hand drying can potentially impact the airborne dissemination of microbial pathogens, including respiratory virus, and so potentially increase the risk of exposure and infection for other washroom users.
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Affiliation(s)
- Ines B. Moura
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Karen Bentley
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Mark H. Wilcox
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom,Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom,*Correspondence: Mark H. Wilcox
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Cunningham B, O'Neill V, Devereux M, McGann D, O'Hora J. Use of a door handle disinfection system to reduce the risks associated with microbial loads on fomites in a healthcare setting. J Hosp Infect 2022; 130:104-107. [PMID: 36113634 DOI: 10.1016/j.jhin.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
Pathogenic organisms, including those that are multi-drug resistant, can survive for extended periods of time on surfaces. Numerous studies show that contaminated hand-touch sites, such as door handles, pose a serious risk for onward transfer to patients. Such surfaces, because of their frequent and common use, do not always receive sufficient cleaning attention. A proposed level of ≤2.5 colony forming units (Cfu's)/cm2 on fomites, could result in fewer transmissions. A door handle disinfection system, utilising an atomising pump (non-aerosol), automatically delivers a pulse of disinfectant to a door handle each time the door is used. Microbial levels on the handles of frequently used door locations, in a busy Rehab unit of an Orthopaedic Hospital were monitored over a 16-week period, to compare microbial loads with and without a door handle disinfection system in place. A sample of two disinfectant types, Steri-7 (Broad spectrum disinfectant) and Dew (Hypochlorous acid), were used in the study. A level of ≤2.5 Cfu/cm2 was recorded on 93% of samples collected where a door handle disinfection system was in use, with 66% of samples showing no microbes recovered. Where a level of >2.5 Cfu/cm2 was recorded, the door handle disinfection system reduced this to a negligible level by the time the next sample was taken, compared with several days where no system was in place. Door handle disinfection systems offer an effective solution to reducing microbial levels on frequently and commonly touched door handles, as an automated solution with minimal additional costs to resources.
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Affiliation(s)
| | - Vikki O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK.
| | | | - Dearbhla McGann
- National Orthopaedic Hospital Cappagh, Dublin, Republic of Ireland.
| | - Jane O'Hora
- National Orthopaedic Hospital Cappagh, Dublin, Republic of Ireland.
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Inkster T, Peters C, Dancer S. Safe design and maintenance of bone marrow transplant units: a narrative review. Clin Microbiol Infect 2022; 28:1091-1096. [DOI: 10.1016/j.cmi.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
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Săveanu CI, Porsega A, Anistoroaei D, Iordache C, Bobu L, Săveanu AE. Cross-Sectional Study to Evaluate Knowledge on Hand Hygiene in a Pandemic Context with SARS-CoV-2. Medicina (B Aires) 2022; 58:medicina58020304. [PMID: 35208627 PMCID: PMC8878756 DOI: 10.3390/medicina58020304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background and Objectives: The basis of any infection control program is hand hygiene (HH). The aim of this study was to investigate knowledge of HH among medical students. Materials and Methods: Students were randomly selected from two Romanian universities and a cross-sectional, questionnaire-based study was conducted between January and May 2021. The answers regarding demographic data and knowledge concerning the methods, the time and the antiseptics used for HH were collected. The selection of the study group was made according to selection criteria in accordance with ethical issues. A descriptive statistical analysis was performed, and a chi-square test was used for data comparison, with a cut-off point of 0.05 for statistical significance. Results: The results indicated that the attitude of the students towards the practice of HH improved significantly. Most students believe that simple HH can control infections. Significant differences were found by the year of study in terms of the hand surfaces included and recommended duration (p < 0.05). Conclusions: In conclusion, the study shows that most respondents have sufficient knowledge on HH, meaning that a higher compliance is required to control infections. The indicated reasons of non-compliance with HH are emergencies and other priorities.
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Affiliation(s)
- Cătălina Iulia Săveanu
- Department I—Surgicals, Faculty of Dental Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
| | - Andreea Porsega
- Faculty of Dental Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.P.); (A.E.S.)
| | - Daniela Anistoroaei
- Department I—Surgicals, Faculty of Dental Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
- Correspondence: or (D.A.); (C.I.); or (L.B.); Tel.: +4-0721-377-269 (D.A.); +4-0745-503-852 (C.I.); +4-0747-896-205 (L.B.)
| | - Cristina Iordache
- Department of Implantology, Removable Prostheses, Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: or (D.A.); (C.I.); or (L.B.); Tel.: +4-0721-377-269 (D.A.); +4-0745-503-852 (C.I.); +4-0747-896-205 (L.B.)
| | - Livia Bobu
- Department I—Surgicals, Faculty of Dental Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
- Correspondence: or (D.A.); (C.I.); or (L.B.); Tel.: +4-0721-377-269 (D.A.); +4-0745-503-852 (C.I.); +4-0747-896-205 (L.B.)
| | - Alexandra Ecaterina Săveanu
- Faculty of Dental Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania; (A.P.); (A.E.S.)
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Gião MS, Vardoulakis S. Aerosols and Bacteria From Hand Washing and Drying in Indoor Air. Front Public Health 2022; 10:804825. [PMID: 35198523 PMCID: PMC8858938 DOI: 10.3389/fpubh.2022.804825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 11/14/2022] Open
Abstract
Effective hand drying is an important part of hand hygiene that can reduce the risk of infectious disease transmission through cross-contamination of surfaces by wet hands. However, hand drying methods may also cause aerosolisation of pathogenic microorganisms if they are present in washed hands. This study investigated experimentally the impact of washing hands and different hand drying methods on the concentration and size distribution of aerosols and bacteria in indoor air. In this experiment, aerosol and bacteria concentrations were measured in indoor air while volunteers rinsed their hands with water or washed with soap and water prior to drying them with paper towels or jet air dryers. Results showed that the concentration of aerosols and bacteria in air increased with people walking in the room and washing hands, with a further increase during the hand drying process. The concentration of aerosols decreased with particle size, with maximum concentrations after drying hands of 6.63 × 106 ± 6.49 × 105 and 2.28 × 104 ± 9.72 × 103 particles m−3 for sizes 0.3 to <0.5 and ≥5.0 μm, respectively. The concentration of bacteria in indoor air after drying hands increased to a maximum of 3.81 × 102 ± 1.48 × 102 CFU m−3 (jet air dryers) and 4.50 × 102 ± 4.35 × 101 CFU m−3 (paper towels). This study indicates that the increase of aerosols and bacteria in air after drying hands with jet air dryers or paper towels are comparable and not statistically different from concentrations associated with walking and washing hands in the same environment. This work can support the development of hand hygiene practices and guidelines for public washrooms.
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Affiliation(s)
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
- *Correspondence: Sotiris Vardoulakis
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Vardoulakis S, Espinoza Oyarce DA, Donner E. Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 803:149932. [PMID: 34525681 PMCID: PMC8390098 DOI: 10.1016/j.scitotenv.2021.149932] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. METHODS We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. RESULTS Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. CONCLUSION Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.
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Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia.
| | - Daniela A Espinoza Oyarce
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Erica Donner
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
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Abstract
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457, USA.
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12
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Marcenac P, Kim S, Molinari N, Person M, Frankson R, Berendes D, McDonald C, Yoder J, Hill V, Garcia-Williams A. Knowledge, attitudes, and practices around hand drying in public bathrooms during the COVID-19 pandemic in the United States. Am J Infect Control 2021; 49:1186-1188. [PMID: 33838180 PMCID: PMC8025600 DOI: 10.1016/j.ajic.2021.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022]
Abstract
Hand drying is the critical, final step of handwashing. A cross-sectional survey of U.S. adults assessed self-reported hand drying practices in public bathrooms and found increased preference for using electric hand dryers, wiping hands on clothing, and shaking hands and decreased preference for using paper towels during the COVID-19 pandemic relative to before. Respondents expressed concerns about contacting SARS-CoV-2 when touching surfaces in public bathrooms which may be influencing self-reported drying method preference.
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Affiliation(s)
- Perrine Marcenac
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA; Epidemic Intelligence Service, CDC, Atlanta, GA.
| | - Sunkyung Kim
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - NoelleAngelique Molinari
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Margaret Person
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Rebekah Frankson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA; CDC COVID-19 Response Team, Atlanta, GA
| | - David Berendes
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | | | - Jonathan Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA; CDC COVID-19 Response Team, Atlanta, GA
| | - Vincent Hill
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Amanda Garcia-Williams
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA; CDC COVID-19 Response Team, Atlanta, GA
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13
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From the hospital toilet to the ward: A pilot study on microbe dispersal to multiple hospital surfaces following hand drying using a jet air dryer versus paper towels. Infect Control Hosp Epidemiol 2021; 43:241-244. [PMID: 33726871 DOI: 10.1017/ice.2021.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Using a bacteriophage to represent microbial contamination, we investigated virus transmission to the hospital environment following hand drying. The use of paper towels resulted in lower rates of virus contamination on hands and clothing compared with a jet air dryer and, consequently, lower contamination of multiple hospital surfaces.
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Chang T, Sepati M, Herting G, Leygraf C, Rajarao GK, Butina K, Richter-Dahlfors A, Blomberg E, Odnevall Wallinder I. A novel methodology to study antimicrobial properties of high-touch surfaces used for indoor hygiene applications-A study on Cu metal. PLoS One 2021; 16:e0247081. [PMID: 33630868 PMCID: PMC7906481 DOI: 10.1371/journal.pone.0247081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/01/2021] [Indexed: 01/30/2023] Open
Abstract
Metal-based high-touch surfaces used for indoor applications such as doorknobs, light switches, handles and desks need to remain their antimicrobial properties even when tarnished or degraded. A novel laboratory methodology of relevance for indoor atmospheric conditions and fingerprint contact has therefore been elaborated for combined studies of both tarnishing/corrosion and antimicrobial properties of such high-touch surfaces. Cu metal was used as a benchmark material. The protocol includes pre-tarnishing/corrosion of the high touch surface for different time periods in a climatic chamber at repeated dry/wet conditions and artificial sweat deposition followed by the introduction of bacteria onto the surfaces via artificial sweat droplets. This methodology provides a more realistic and reproducible approach compared with other reported procedures to determine the antimicrobial efficiency of high-touch surfaces. It provides further a possibility to link the antimicrobial characteristics to physical and chemical properties such as surface composition, chemical reactivity, tarnishing/corrosion, surface roughness and surface wettability. The results elucidate that bacteria interactions as well as differences in extent of tarnishing can alter the physical properties (e.g. surface wettability, surface roughness) as well as the extent of metal release. The results clearly elucidate the importance to consider changes in chemical and physical properties of indoor hygiene surfaces when assessing their antimicrobial properties.
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Affiliation(s)
- T. Chang
- Department of Chemistry, KTH Royal Institute of Technology, Div. Surface and Corrosion Science, School of Engineering Sciences in Chemistry, Biotechnology and Health, Stockholm, Sweden
- AIMES—Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M. Sepati
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - G. Herting
- Department of Chemistry, KTH Royal Institute of Technology, Div. Surface and Corrosion Science, School of Engineering Sciences in Chemistry, Biotechnology and Health, Stockholm, Sweden
| | - C. Leygraf
- Department of Chemistry, KTH Royal Institute of Technology, Div. Surface and Corrosion Science, School of Engineering Sciences in Chemistry, Biotechnology and Health, Stockholm, Sweden
| | - G. Kuttuva Rajarao
- Department of Industrial Biotechnology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - K. Butina
- AIMES—Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A. Richter-Dahlfors
- AIMES—Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- KTH Royal Institute of Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Fibre and Polymer Technology, Stockholm, Sweden
| | - E. Blomberg
- Department of Chemistry, KTH Royal Institute of Technology, Div. Surface and Corrosion Science, School of Engineering Sciences in Chemistry, Biotechnology and Health, Stockholm, Sweden
| | - I. Odnevall Wallinder
- Department of Chemistry, KTH Royal Institute of Technology, Div. Surface and Corrosion Science, School of Engineering Sciences in Chemistry, Biotechnology and Health, Stockholm, Sweden
- AIMES—Center for the Advancement of Integrated Medical and Engineering Sciences at Karolinska Institutet and KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Microbiological Assessment of the Different Hand Drying Methods and Washroom Environment Cross-Contamination. Int J Microbiol 2020. [DOI: 10.1155/2020/8815147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Proper hand drying is a fundamental part of the hand hygiene process looking at optimizing the elimination of potentially pathogenic microbes. This research compared the effectiveness of three different hand drying methods—paper towels, the use of warm air dryers in stationary hands position, and the use of air drying while hand rubbing—and their potential for cross-contamination of other users and the surrounding environment. One hundred sixty samples were collected from finger pads and palms, before and after drying. The outlet of the air dryers, air current emitted from the air dryers, and washroom environment air were also tested. The study reported that paper towels were more successful in eliminating bacteria and lead to less contamination to the washroom environment compared to the air dryers. The average number of bacteria obtained from volunteers using hand air dryer while hand rubbing was significantly higher than drying with air dryer while holding hands stationary. Plates exposed to the turned-off dryer for 5 minutes gave an average of only 25 colonies/plate, while plates exposed to the air outlet of the turned-on warm air dryers provided 292 colonies/plate. Placing Petri dishes at least one meter away from the dryer in the washroom for 30 minutes gave 72.5 colonies/plate. The current research also documented frequent contamination of public washroom environments and showed dissemination of potential pathogens, including Escherichia coli (E. coli), Klebsiella species, Bacillus cereus (B. cereus), Staphylococcus aureus (S. aureus), and coagulase-negative Staphylococci. Over 70.0% of Staphylococci were resistant to at least three antibiotics and 50.0% revealed coresistance to at least four antibiotics including penicillin, erythromycin, clindamycin, and co-trimoxazole. The method of hand drying may serve as a risk factor of cross-contamination from users to the environment and subsequent users and as reservoirs of drug-resistant bacteria in public washrooms.
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16
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Gammon J, Hunt J. COVID-19 and hand hygiene: the vital importance of hand drying. ACTA ACUST UNITED AC 2020; 29:1003-1006. [DOI: 10.12968/bjon.2020.29.17.1003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.
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Affiliation(s)
- John Gammon
- Professor, Infection Prevention, College of Human and Health Sciences, Swansea University
| | - Julian Hunt
- Research Officer, Infection Prevention, College of Human and Health Sciences, Swansea University
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17
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Reynolds KA, Sexton JD, Norman A, McClelland DJ. Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature. J Appl Microbiol 2020; 130:25-39. [PMID: 32794646 PMCID: PMC7818469 DOI: 10.1111/jam.14796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.
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Affiliation(s)
- K A Reynolds
- Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - J D Sexton
- Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - A Norman
- Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - D J McClelland
- Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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18
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Ma JJ. Blowing in the wind: Bacteria and fungi are spreading from public restroom hand dryers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:52-60. [PMID: 32720586 DOI: 10.1080/19338244.2020.1799183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aimed to identify and quantify fungi and bacteria in the airflow of restroom hand dryers in public areas. Airflow from restroom hand dryers in 8 retail locations was tested using three types of culture media, followed by PCR and sequence analysis to identify microbial species. Both bacterial and fungal colonies were detected in all locations. The number of colonies did not vary significantly across different locations, suggesting a similar level of microbial spread by hand dryers between different types of commercial stores. Molecular analysis revealed 24 bacterial species and 40 fungal species. Of these species, 48% (31/64) have been reported to be implicated in various infections in humans, primarily those with underlying medical conditions. This study is the first to demonstrate the spread of fungi by the airflow of restroom hand dryers, and the first to show the prevalence of different fungal and bacterial species spread by restroom hand dryers in common public areas.
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Affiliation(s)
- Jessie J Ma
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Fabritius M, Al-Munajjed AA, Freytag C, Jülke H, Zehe M, Lemarchand T, Arts JJ, Schumann D, Alt V, Sternberg K. Antimicrobial Silver Multilayer Coating for Prevention of Bacterial Colonization of Orthopedic Implants. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1415. [PMID: 32245004 PMCID: PMC7143109 DOI: 10.3390/ma13061415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
Due to increasing rates of periprosthetic joint infections (PJI), new approaches are needed to minimize the infection risk. The first goal of this study was to modify a well-established infection model to test surface-active antimicrobial systems. The second goal was to evaluate the antimicrobial activity of a silver multilayer (SML) coating. In vitro tests with SML items showed a >4 Log reduction in a proliferation assay and a 2.2 Log reduction in an agar immersion test (7 d). In the in vivo model blank and SML coated K-wires were seeded with ~2 × 104 CFU of a methicillin-sensitive Staphylococcus epidermidis (MSSE) and inserted into the intramedullary tibial canal of rabbits. After 7 days, the animals were sacrificed and a clinical, microbiological and histological analysis was performed. Microbiology showed a 1.6 Log pathogen reduction on the surface of SML items (p = 0.022) and in loosely attached tissue (p = 0.012). In the SML group 7 of 12 SML items were completely free of pathogens (cure rate = 58%, p = 0.002), while only 1 of 12 blank items were free of pathogens (cure rate = 8%, p = 0.110). No silver was detected in the blood or urine of the SML treated animals and only scarcely in the liver or adjacent lymph nodes. In summary, an in vivo infection model to test implants with bacterial pre-incubation was established and the antimicrobial activity of the SML coating was successfully proven.
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Affiliation(s)
- Martin Fabritius
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
| | | | | | | | - Markus Zehe
- QualityLabs, Neumeyerstr. 46a, 90411 Nuremberg, Germany;
| | | | - Jacobus J. Arts
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, 6202 Maastricht, The Netherlands;
| | - Detlef Schumann
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
| | - Volker Alt
- Department of Trauma Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Katrin Sternberg
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
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20
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Affiliation(s)
- C Lynch
- Healthcare Infection Society, Journal of Hospital Infection, Montagu House, Wakefield Street, London, WC1N, UK.
| | - N Mahida
- Healthcare Infection Society, Journal of Hospital Infection, Montagu House, Wakefield Street, London, WC1N, UK
| | - B Oppenheim
- Healthcare Infection Society, Journal of Hospital Infection, Montagu House, Wakefield Street, London, WC1N, UK
| | - J Gray
- Healthcare Infection Society, Journal of Hospital Infection, Montagu House, Wakefield Street, London, WC1N, UK
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21
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Chia PY, Sengupta S, Kukreja A, S L Ponnampalavanar S, Ng OT, Marimuthu K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control 2020; 9:29. [PMID: 32046775 PMCID: PMC7014667 DOI: 10.1186/s13756-020-0685-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Sharmila Sengupta
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore
| | | | | | - Oon Tek Ng
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore. .,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Rd, Singapore.
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22
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Redway K, Barbut F, Wilcox M. ‘The method used to dry washed hands affects the number and type of transient and residential bacteria remaining on the skin’. J Hosp Infect 2019; 102:473-474. [DOI: 10.1016/j.jhin.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
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23
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Mutters R, Warnes SL. The method used to dry washed hands affects the number and type of transient and residential bacteria remaining on the skin. J Hosp Infect 2018; 101:408-413. [PMID: 30537524 DOI: 10.1016/j.jhin.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Widespread antibiotic resistance has led to fears that we are entering a post-antibiotic era and the relatively simple premise of hand washing to reduce transfer of bacteria and viruses has never been more important. Much of the emphasis has been on hand-washing technique, type of soap, and maintaining compliance but effective drying of the hands is just as important. AIM To compare the efficacy of drying washed hands with a jet air dryer or paper towels to remove transient bacterial contamination and to determine the effect on residential flora. METHODS Eighty volunteers were recruited. The entire surfaces of volunteers' hands were artificially contaminated with Escherichia coli before being washed and dried; then bacteria remaining on the skin were recovered and enumerated. In the second part of the study the number and types of bacteria comprising the natural flora remaining on washed and dried hands were determined. FINDINGS Significantly fewer transient and residential bacteria remained on the skin if hands were dried with a jet air dryer (P < 0.001). Drying hands with paper towels increased the number of resident bacteria, including potentially pathogenic species, released from the volunteers' skin, compared to a jet air dryer. CONCLUSION The number and types of bacteria remaining on washed hands were affected by the drying method. Hands dried with a jet air dryer harboured fewer viable bacteria, reducing the risk of infection transmission via touch. This could be especially important for healthcare workers who are constantly in contact with large numbers of vulnerable patients.
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Affiliation(s)
- R Mutters
- Institute for Medical Microbiology and Hygiene, Philipps University of Marburg, Marburg, Germany.
| | - S L Warnes
- Independent Scientific Writer, Southampton, UK
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